Physiologic Effects of High Flow Nasal Therapy in Patients With Acute Hypoxemic Respiratory Failure (OPTIFLOW)

University Hospital of Bordeaux

Status: Completed

Conditions: Respiratory Failure

Treatments: Procedure: O2stand; Procedure: CPAP; Procedure: Optiflow

Study type: Interventional

Funder types: Other

Identifiers

NCT01056952

CHUBX 2009/15

Details and patient eligibility

About

The aim of the study is to assess, in patients with acute hypoxemic respiratory failure, the short term physiologic effects of the high flow oxygen nasal therapy (Optiflow), in term of inspiratory muscle effort, gas exchange, comfort and dyspnea

Full description

The administration of a known concentration of oxygen is an important part of routine care of the patient admitted in intensive care unit for acute hypoxemic respiratory failure. A new high flow oxygen delivery system (Fisher and Paykel Health care) has been developed (Optiflow). The system used a heated humidifier and heated breathing circuit via a nasal interface. High flow nasal therapy (Optiflow) is associated with the generation of significant positive airway pressure in healthy volunteers. Positive expiratory pressure may have a number of benefits in respiratory failure which include improved ventilation/perfusion matching with improved oxygenation, reduced airways resistance and reduced work of breathing. Moreover high flow nasal therapy may improve oxygen administration by decreasing oxygen dilution, decreasing death space and using high levels of humidification

Enrollment: 12 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Acute respiratory insufficiency, defined as the PaO2/FIO2 ratio of 300 mm Hg or less after breathing oxygen
• The presence of lung infiltrates on a posteroanterior chest radiograph

Exclusion criteria

• Face or cranial trauma or surgery
• Patients younger than 18 years
• History of COPD
• Acute respiratory acidosis (defined as a pH <7.30 and a PaCO2 >50 mm Hg)
• Hemodynamic instability with arterial pressure < 90mmHg
• Respiratory instability with PaO2/FiO2<100mmHg
• ventricular arrhythmias
• Excess respiratory secretions.
• Upper gastrointestinal bleeding
• Recent gastric or oesophageal surgery
• Tracheostomy or other airways disorders
• Pneumothorax
• Contraindication of gastric probe insertion
• Impossibility to insert the oesophageal probe

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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12 participants in 2 patient groups

Optiflow then CPAP

Experimental group

Description:

Standard low flow oxygen therapy then High flow oxygen nasal therapy (Optiflow)then Continuous positive airway pressure (CPAP)

Treatment:

Procedure: CPAP

Procedure: Optiflow

Procedure: O2stand

CPAP then Optiflow

Experimental group

Description:

Standard low flow oxygen therapy then Continuous positive airway pressure (CPAP)then High flow oxygen nasal therapy (Optiflow)

Treatment:

Procedure: CPAP

Procedure: Optiflow

Procedure: O2stand